THE recent tragic death of a young doctor (The Star, April 12) has led to renewed discussions on the working conditions and training of housemen in Malaysia. In initial news reports, working long hours was implicated as a source of stress for the young doctor.
In fact, the complaints about “long working hours” of housemen had been forthcoming for some time and the Health Ministry implemented a flexi-hours system for housemen in the third quarter of last year.
The Malaysian Medical Association (MMA) has been monitoring the system since its implementation, and has continually sought feedback from housemen as well as from medical officers (MOs) and specialists involved in houseman training.
We have called on the ministry to carry out a comprehensive review of the new system, not just in terms of the workload of the housemen but, more importantly, in terms of how it affects their training.
Based on feedback, we are concerned about the reduction in houseman training time, resulting in inadequate exposure to patients, limited opportunities for observing and performing basic procedures and operations, and lack of continuity of care for patients.
We would like to emphasise that the housemanship training period is a critical time in a doctor’s career, the time when he/she applies all that he/she has learnt during medical school in real-life situations – fully supervised by more senior doctors.
It is thus extremely important that the young doctor uses this time to learn, and to gain as much experience as possible, as it will be the foundation of his/her future career in medicine.
The medical profession is such that one cannot work “by the clock”. Sickness does not recognise “office hours” or “shift times”.
When caring for a sick patient, e.g. someone who has just been admitted or someone who has taken a turn for the worse, a doctor has to examine, send for the necessary tests, and do the needful to resuscitate and stabilise the patient before “clocking out”.
The nature of the profession calls for such a commitment and dedication, and this culture is instilled in us during our formative years – medical school and housemanship.
Young doctors are also taught to put their patients’ interests and welfare first, before their own.
Sadly, this culture of commitment and caring seems to be getting lost in the name of improving “quality of life”.
This brings up what is, in our opinion, a more important negative impact of the flexi-hours system – the possibility that this will result in doctors lacking a sense of responsibility for a patient.
While discussing the plight of young house officers, the equally (or more) strenuous working hours of MOs and specialists in government hospitals may have been forgotten.
Training and supervision of housemen is the responsibility of MOs and specialists in the respective departments, who are already overworked with patient care.
These more senior doctors are finding it difficult to cope with training the large numbers of house officers being posted to our public hospitals, especially the many who lack basic medical knowledge and skills.
Which of course brings into question the quality of our medical graduates now. In this regard, the MMA welcomes the recently tabled amendments to the Medical Act 1971 which includes a proposal for the establishment of a Medical Qualifying Committee to look into the accreditation of qualifications of both local and international training institutions.
However, we are disappointed that the original proposal – for a common qualifying examination for medical graduates – was set aside.
We call upon the Malaysian Medical Council to carefully examine the quality of medical schools (local and international) and to take the necessary action where shortfalls in quality occur.
With regard to training of housemen, the MMA feels strongly that decisions on these matters should be left to medical professionals, with no external interference from parents, politicians or others.
As doctors, we know what training is needed to produce a good doctor, and hard work and long hours are certainly some of the necessary “evils” that we cannot escape from!
The MMA calls on the ministry to ensure that the number of house doctors posted to each unit is based on the number of trainers (i.e. specialists and MOs) available.
Only then will specialists and medical officers be able to guide each houseman in the right direction.
The MMA would also like to recognise the specialist and medical officers who have continued to train housemen despite being overworked themselves.
Dr MARY SUMA CARDOSA, President, MMA.
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